The present invention relates generally to surgical instruments, and more specifically to surgical instruments for tissue manipulation during surgical procedures, especially in laparoscopic surgery of the abdomen.
Laparoscopy facilitates the performance of a variety of surgical procedures of the abdomen, such as cholecystectomies, appendectomies, hernia repairs, hysterectomies and the like, without requiring large incisions or the invasive procedures of conventional surgical techniques. In laparoscopy, the abdominal cavity is distended using gas insufflation, so as to lift the wall of the abdominal cavity away from the underlying organs. A video scope is inserted through a cannula or trocar sleeve into the abdomen and connected to a monitor so as to provide visual guidance to the surgeon. One or more additional trocar sleeves are placed in the abdomen to allow introduction of surgical tools, such as retractors, cutting instruments and the like. Such trocar sleeves have a sealed passage through which instruments may be inserted, providing a leak-resistant entryway into the insufflated abdomen.
One disadvantage of laparoscopic surgical procedures is the limited access to the surgical site available to the surgeon. Entry to the site is limited to the small incisions or trocar sleeves through the abdominal wall. Any manipulation of internal tissue, for example, positioning a duct for ligation, or moving tissue to allow better access to or visibility of a particular location, must be performed using long handled instruments insertable through the trocar sleeves or incisions.
It is known to use surgical clips or clamps for the purpose of clamping vessels or manipulating tissue. Typically, such clamps have a pair of movable jaws biased by a spring into a closed position, allowing the clamp to be placed on a vessel or portion of tissue and be firmly retained thereon. Examples of such clamps can be seen in U.S. Pat. No. 4,932,955 to Merz et al., U.S. Pat. No. 4,605,990 to Wilder et al., U.S. Pat. No. 5,074,870 to Von Zeppelin, U.S. Pat. No. 3,809,094 to Cook, U.S. Pat. No. 3,404,677 to Springer and U.S. Pat. No. 4,051,844 to Chiulli and U.S. Pat. No. 4,988,355 to Leveen et al.
It is also known in laparoscopic surgical procedures to use long-handled instruments for applying clamps to internal tissue within the abdominal cavity. Such clamp applicators typically include a pair of movable handles at the proximal end of the applicator and a pair of movable jaws at the distal end, wherein a clamp is placed in the jaws, the distal end of the applicator is inserted through a trocar sleeve into the abdomen and positioned at the desired tissue location, and the handles are actuated so as to apply the clamp to the tissue. Illustrative examples are seen in U.S. Pat. No. 4,174,715 to Hasson, and British Patent No. 1,452,185 to Wolf. Other tissue manipulation or clamping instruments with possible application to laparoscopic procedures are seen in U.S. Pat. No. 4,607,620 to Storz, U.S. Pat. No. 5,074,869 to Daicoff, U.S. Pat. No. 4,393,872 to Reznik et al., U.S. Pat. No. 2,549,731 to Wattley and U.S. Pat. No. 1,274,669 to Bohn.
However, known devices for manipulating tissue in laparoscopic procedures suffer from certain disadvantages. Known manipulating instruments typically have long, rigid members between the distal end and the handles at the proximal end, limiting the positionability of such devices. In addition, once such devices have been used to manipulate tissue to a desired position, the devices must be held in that position by the surgeon or an assistant. Further, the usefulness of known devices for positioning of tissue during laparoscopic procedures is limited by the necessity of having a trocar sleeve or incision in place proximate to the tissue to be manipulated in addition to those trocar sleeves being used for the surgical instruments employed in the procedure. Moreover, the size of known manipulation instruments requires that the additional trocar sleeve be of considerable size (e.g. 10 mm), increasing the invasiveness of the procedure.
In certain procedures, it is further desirable to be able to manipulate tissue in various directions, including both toward and away from the point of access (e.g. incision or percutaneous cannula) into the body. This is particularly true, for example, for the retraction of the gallbladder during laparoscopic cholecystectomy procedures. In such procedures, using a system which allows retraction of the gallbladder toward the surgeon, a cannula is optimally placed high into the rib cage through which the retraction device is introduced. However, this poses a significant risk of patient injury due to the close proximity to the diaphragm. To eliminate this risk, the cannula is ideally placed in a lower position below the ribs. However, this requires a retraction system which facilitates retraction in a direction away from the position of the cannula (and the surgeon).
For these and other reasons, an improved system and method for manipulating internal tissue during laparoscopic and other surgical procedures is desired. The system and method should allow greater flexibility in positioning from various points and at various angles, including both toward and away from the surgeon. The system and method should allow positioning through a trocar sleeve or similar small access way and should minimize the need for placement of trocar sleeves in addition to those already in place for insertion of surgical instruments. Further, the system and method should allow the tissue to be maintained in a desired position without the need for ongoing manual intervention by the surgeon or an assistant.